EXAMPLES
This patient presented with an ongoing infection and discoloration of his bottom front tooth.
An examination revealed a persistent infection from a previous, poorly done root canal treatment, which also contributed to the discoloration.
The root canal treatment was redone to get rid of the infection.
This was followed by internal bleaching of the tooth to improve the aesthetics.
A follow-up scan and examination confirmed the complete healing of the infection.
Pre-op image of retreatment case with 2 broken files
Completed root canal treatment anterior view
Pre-op image of retreatment case with 2 broken files
Patient referred for retreatment of TN46. History of previous treatment with file fractures in ML and MB canals and persistent pain.
Diagnosis: Previously treated tooth with Symptomatic Chronic Apical Periodontitis.
Treatment: 2 stage with triple antibiotic paste in between appointments. Broken files removed with Terauchi method using mainly straight US tips. Both files suffered secondary fractures at first attempt but were eventually successfully dislodged and removed.
Irrigation performed with 6%NaOCl, EDTA using Endovac with EDDY activation. Final cleaning and disinfection performed with Biolase Waterlase and EPIC DIODE laser.
Obturation: BC TOTALFILL with single cone GP. Final core build up with EVERX bulkfill. Patient advised to get coronal coverage restoration as soon as possible.
The outcome of treatment has to be evaluated. In endodontics, the use of CBCT imaging is invaluable for diagnostics and for healing reviews. This is an 18 month healing review of a 26 retreatment showing resolution of the initial large apical lesion.
Diagnosis in Endo is extremely important albeit often tricky with pain sometimes being multifactorial.
This is a case of a 60-year-old lady who presented with acute pain and temp sensitivity lower left. The obvious reason was the 36 with a missing restoration which was subsequently endodontically treated. However, examination revealed the 37 and 24 also being symptomatic, both due to coronal fractures related to para function. Endodontic treatment was performed on the 37 due to pulp exposure. In the case of the 24, the pulp was not exposed and replacement of the existing composite restoration to include the fractured buccal cusp and eliminate the para function, resolved the issue.
All of these issues were complicated by a previous diagnosis of atypical Trigeminal Neuralgia. Following the above treatments, which included some occlusal adjustments, most of the Neuralgia symptoms subsided. Some signs of Neuralgia are however still present so the original diagnosis was partially correct but investigations at the time apparently did not include occlusal assessment. As most patients present with an obvious problem tooth, occlusal assessment is often overlooked. It should however be part of our exams and timeously addressed where needed.